Agenda-setting criteria of abolition of user fees health policies in West Africa.

Principal investigator: Manuela De Allegri, IPH Heidelberg

Funding: Africa Initiative Research Grant 2011 (Canadian Research Council)

Partners:
University of Montreal, Canada 
Bocconi University, Italy

Project description: 
In July 2010, the African Union pleaded to abolish user fees for women of reproductive age and children below five years of age. This African appeal followed a similar declaration signed by all United Nations agencies and by most international donor countries, including Canada or NGOs. The absence of adequate social health insurance coverage in Africa leaves people with no capacity to pay unable to access health care. This has motivated some African countries to abolish user fees. Target populations as well as the criteria on the basis of which such policy decisions have been made vary considerably across countries. National political contexts as well as the specific relationship with aid donors have influenced this process.

Building on an experience with health policy makers in two French‐speaking West‐African countries (Mali and Burkina Faso), this exploratory research study aims to identify the agenda‐setting criteria on the basis of which decisions on user fee abolition are made. The study will take place in Burkina Faso and in Mali and will target key policy makers in both countries as primary respondents. It will adopt a mixed methods approach, combining qualitative and quantitative methods of data collection and analysis, and will entail two overlapping phases. The first phase will be characterized by an exploratory study design, i.e. qualitative methods will be used to inform the development of the quantitative tool. The team will conduct three Focus Group Discussions (FGD) with key policy makers to elicit the criteria which health policy makers value as important when deciding on policies relevant to the abolition of user fees. Then the criteria and the balance across criteria identified during the FGD will be used to define the attributes needed to compile the scenarios for a Best-Worst Scaling experiment. Health policy makers will be asked to choose their preferred options from a set of hypothetical sets. The second phase will be characterized by an explanatory study design, i.e. qualitative methods will be used to understand and explain the results of the quantitative study component. FGD and individual interviews with a sub‐sample of purposely selected health policy makers will be used to understand the choices made during the B-W Scaling.

Findings will show policy makers the importance of considering, when designing health financing reforms, the complexity of factors influencing access to care beyond user fees alone. Findings will also highlight the importance of targeting specific groups of people and/or of medical conditions in a context of limited resource availability.

Contact: Manuela De Allegri (Manuela.de.allegri@urz.uni-heidelberg.de)